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These studies have also shown that some of the complications of the pregnancy such as anaemia, toxemia and premature delivery may result from a diet inadequate in the nutritional needs of the mother and the baby. The process of childbirth becomes painful mainly due to a large foetus in the womb. This results from an excessive intake of denatured foods such as white flour products, white sugar, refined cereals, meat and other flesh foods during pregnancy. Other factors contributing to the suffering of the women include lack of exercise, unhygienic habits of living and restrictive garments. It is quite wrong to assume that the larger the baby at birth, the healthier it will be. Such a child will also be covered with unnecessary fat and watery tissue, which is really waste matter and an impediment to health. A proper diet during pregnancy is the most important factor for not only having a painless childbirth but also for giving birth to a healthy baby. The idea of " eating for two ", which is so prevalent today, is absurd and it leads to overeating, resulting in an unusually, heavy baby. The unborn child will require an adequate amount of orgnic minerals from its mother for building of bones and tissues and this can be supplied by natural food such as fruits, raw vegetables, whole meal bread, and milk, unnatural foods like white bread, sugar, meat, pudding and pies are very deficient in organic mineral matter and their intake during pregnancy leads to loss and decay of teeth, general debility and other ailments after childbirth. This can be avoided by eating plenty of fresh fruits and vegetables of high fibre content. The diet for expectant mothers should be planned along the following lines by securing a safe and easy child birth and a healthy child: Breakfast: Fresh fruit in season or grated raw carrot, or any other raw salad and milk. Lunch: Steamed vegetables, as obtainable, whole wheat chappatis and a glass of buttermilk. Dinner: A good-sized raw salad of any suitable vegetables, sprouted mung beans, whole wheat bread, butter or cottage cheese and prunes or other dried fruit as dessert. Besides proper diet, the expectant mother should be given daily a dry friction and cold sponge during the first five or six months of pregnancy. A dry friction bath can be taken with a rough dry towel or with a moderately soft bristle brush. If a brush is used, the procedure should be as follows: take the brush in one hand and begin with the face, neck and chest. If a towel is used, it should be fairly rough, and the same process should be followed. This bath excites to increased activity all the functional processes lying at or near the surface of the body. The cold sponge is taken as follows: wring out a towel in cold water, and rub the whole body in the manner described for the friction bath. If, during the process of rubbing the towel becomes too dry, it should be wrung out again. A good walk should be taken daily right upto the end of the eighth month and all household duties should be performed in a normal way. This will keep the muscles of the womb and pelvis in good condition and will ensure safe and easy childbirth. The exercise should, however, always be well within the capacity of the prospective mother and all undue strain, worry or excitement should be avoided. Recoupment For the really healthy woman, recoupment after childbirth poses no problem. Women among primitive races are able to rise and go about their duties immediately after delivery. In fact it is customary to keep them in bed for a considerable time after child birth. It is usually due to abnormal slowness with which the generative organs assume the former position. As in the case case of pregnancy, diet plays an important role in the recoupment after childbirth. The diet of the mother for the first two days after confinement should consist of only fresh juicy fruits with some warm milk. A salad with thin whole meal bread and butter may be added to the diet the next day. The diet may thereafter be extended gradually until it approaches the pre-natal diet outlined above. The diet should exclude white bread or white flour products, sugar, jam, pastries, puddings, pies, heavy, greasy and fried foods. Strong tea, coffee, alcohol, condiments, pickles, and vinegar should be strictly avoided. The contraction of uterus will help expel any portion of the placenta which may still remain following delivery. If those mothers who are afraid of losing their figures would try nursing their babies, they would discover their figures actually improve after child birth. The child should be given four feeds a day at four-hourly intervals but no feeds should be given during the night. Breast-fed babies are, therefore, less prone to gastrointestinal and respiratory diseases. When a mother can partly feed a child, she should give it two feeds of her own and two bottle feeds or one of her own and three bottle feeds. Those mothers who suffer from diseases like high blood pressure, diabetes, heart trouble, should not breast feed their babies. Where children are entirely breast-fed, they need nothing more than the milk they receive from their mothers. Children on bottle feed, should be given some orange juice daily, in addition to the. If they are given starchy foods such as bread, or oatmeal before weaning, it will lead to the early development of such child ailments as cough, colds, measles, whooping cough and so on as babies lack the proper enzymes needed for their digestion before that age. At the age of one year, a baby should be given about a litre of milk with fruit juices daily. If a baby shows no inclination for food or a certain day, it should be given as much as it wishes for and no more. The assumption that the baby should have a certain amount of food every day have no basis. On the other hand, if the baby does not appear to be satisfied with the quantity of its food and wants more at a feed, it should be given as much as it wants. This may occur any time before 28 weeks of gestation but is most common during the first 12 weeks of pregnancy. When miscarriage occurs repeatedly at a certain period of pregnancy, it is termed " habitual abortion ". It is one of the most perplexing problems of gyanaecology and a major cause of maternal mortality. A woman who has suffered two or more terminations of this sort consecutively is said to be a case of habitual abortion. Symptoms Pains of the same character as labour pains and bleedings are the two main symptoms of possible abortion. In later weeks when the foetus is well developed, if it dies in the uterus, it leads to maceration of the body. Sometime after a few more days, the foetus gets dehydrated and the fluid surrounding the foetus gets dried away. Causes One of the most important cause of habitual abortion is a congenital malformation of the uterus. A hysterogram, before the woman becomes pregnant, will be useful in detecting any abormality, so that she is made aware of her case.

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Histological studies revealed that the soluble gel fraction derived from the seeds was more effective than Omeprazole in preventing lesion formation. Fenugreek lowers blood sugar levels, and has been used experimentally as an oral insulin substitute. If you are diabetic, you should be aware that consuming fenugreek might interfere with your insulin therapy. This review will be helpful to carry out more scientific investigations to prove the medicinal properties of fenugreek in human volunteers. Protective effect of fenugreek (Trigonella foenum graecum) seeds in experimental ethanol toxicity. Chemical constituents of the stems and leaves of Trigonella foenum-graecum L1997; 22(8):486-7, 512. Studies on flavonoids from Fenugreek (Trigonella foenumgraecum L 1998; 23(10):614-6, 639. Inhibition of triiodothyronine production by fenugreek seed extract in mice and rats. Evaluation of the potential antifertility effect of fenugreek seeds in male and female rabbits. Effects of fenugreek seeds (Trigonella foenum greaecum) extract on endurance capacity in mice. While every effort has been made to obtain permission for the inclusion of materials, and also to verify that information is from a reputable source, checks have not been possible for all entries. Therefore, users are encouraged to follow up with the original references when considering using sections of this resource. This resource is for information only and should not be used for the diagnosis or treatment of medical conditions. Cover: A young woman producing low cost, First edition, 2012 hygienic sanitary pads in Mirpur, Dhaka. This educational adequate consideration of the menstrual needs of women and empowering resource tackles without shame or can bring. Globally, approximately 52% of the female population (26% of the total population) is of reproductive age. Most Unfortunately, the silence and stigma surrounding of these women and girls will menstruate each month for menstruation makes fnding solutions for menstrual between two and seven days. Yves worked for the most part of three decades committing his working life to improving water, sanitation, hygiene and environmental health in humanitarian and development contexts around the world; frst with Medecins Sans Frontieres and then with the World Health Organisation. If the situation does not change, it may not be need somewhere private to change sanitary cloths or pads; possible for development programmes to achieve their goals. Even when gender inequalities are addressed, Lack of social support deeply embedded power relations and cultural taboos Taboos surrounding menstruation exclude women and persist; most people, and men in particular, find girls from many aspects of social and cultural life as menstrual hygiene a difficult subject to talk about. As a result, Lack of information and awareness women and girls are often denied access to water and Young girls often grow up with limited knowledge of sanitation when they need it most. Menstruation continues until they reach menopause, when menstruation ends, usually between their late forties and mid ffties5. They can 22 detaches leading 3 also experience emotional and psychological changes (eg to menstruation. Days 1-7 heightened feelings of sadness, irritability or anger) due to 21 Menstruation. These differ from culture to culture infertile), look in a mirror (or it will lose its brightness), and practitioners should fnd out what applies in their or touch a plant (or it will die). Christianity9 the Old Testament of the Bible indicates that a menstruating woman is impure, and that most things she touches become unclean. Islam12 For the entire duration of menstruation, a woman is considered ritually impure. It is also believed that a woman can use her menstrual blood to impose her will on a man17. They believe this will help the wounds heal quicker and prevent scars being left behind18. These booklets have can be done through the use of booklets for girls and used anonymous case studies from girls on their frst women, and making them also available for boys and experiences of getting their menstrual period and advice men to learn from. Menorrhagia Excessive, very heavy and prolonged bleeding (this can lead to anaemia and be fatal if untreated). Prolonged use of the same management pad will also increase the risk of infection. Insertion of unclean material into vagina Bacteria potentially have easier access to the cervix and the uterine cavity. Health Menstruation is a biological Provide accurate and user There are a number of process of the female friendly information on relevant sub-sectors reproductive system. Menstrual hygiene is not commonly spoken about, either these initial efforts to build the confdence and between women or between women and men. The subject competence of staff in talking about menstrual hygiene will is taboo in many cultures and shrouded in myths and be reinforced further through organisational commitment traditions. Presenting women with simple facts on menstruation and providing easy solutions, such as how to make low-cost sanitary pads, created further demand from communities to expand menstrual hygiene promotion. Consequently, community hygiene promoter Nurul Islam was uncomfortable discussing menstruation hygiene, although it was a part of his role to educate the women and girls in his village about the dangers of using dirty rags. Costing 2: National distribution Lack of sanitation, hand-washing facilities and hygiene In parallel a process is on-going to develop a national set education in schools makes it even more difficult for girls of school water, sanitation and hygiene guidelines by four to handle menstruation. The major reason was that and decisions about the materials and/or products to be cloths have always been used for this purpose in their supported. When considering cloth as a sanitary material, it is important to evaluate its softness, absorbency, colour and drying speed. Towelling is too rough to for sanitary protection be used as the main fabric, but provides good absorbency if covered by a softer fabric. It is possible to attach them to a belt worn around the waist, keeping the pad in place. Tampons have a cotton thread attached to them, which remains outside of the body and is used for removal. It is recommended that they are only used for short periods of time before removal and cleaning. Successful operations have been set up in countries including, but not limited to, India, Bangladesh, Ethiopia and Rwanda.


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Comparison of Enteroscopy brush before biopsy, suction cytology, brush after 1 biopsy and endoscopic biopsy in the diagnosis of carci 2 Evaluation of the small bowel is possible by a noma oesophagus. Enteroscopy can be either push Endoscopic brush cytology and biopsy in the diagnosis 8 enteroscopy or balloon enteroscopy where peri of cancer of the upper gastrointestinal tract. Endoscopic dyeing 4011 video camera and transmitter that transmits method for the diagnosis of early gastric cancer and intestinal metaplasia of the stomach. This does ensure that the Endoscopic determination of the extent of early ulcer 4 entire small bowel can be evaluated. Emergency banding lig of patients with suspected small intestinal bleeding: 7 ation versus sclerotherapy for the control of active results of a pilot study. Guest 9 1011 1 2 3 4 5 6 7 8 9 2011 Plain Radiology 1 Aims 2 Lateral Soft Tissue Neck 3 To explain the indications for and types of 4 imaging available. This 5 chapter discusses the commonly used imaging the erect chest x-ray with the beam centred at 6 methods with indications, contraindications the level of the diaphragm is the investigation of 7 and some discussion about technique and inter choice for detecting extraluminal intra-abdom 8 pretation. This becomes especially relevant in gas to collect either just below the diaphragm or 5 young people because of the increased risk of lateral to the liver so ideally the lm should be 6 a lifetime cancer from ionising radiation or obtained with the patient having been in the 7 in patients who are going to undergo repeated erect position for 10 minutes or more. Erect chest X-ray demonstrates a large amount of 1 free gas below the diaphragms following caecal perforation. Triangular air collections may be 9 calci cation or other radio-opaque material, extraluminal (Figure 22. These may only be identi ed if they lie 7 outside the normal distribution of bowel gas. This is seen in necro 5011 tising enterocololitis following umbilical vein 1 Figure 22. Plain film of the abdomen shows the falciform catheterisation and in erythroblastosis fetalis. Gall bladder stones are visible on a plain 2 abdominal lm in about 10% of cases, and are 3 characteristically laminated and polygonal. The use of 3011 showing gas (arrowheads) within the mesenteric arcades and the portal venous system in the liver in this patient with Gastrogra n, which is a hyper-osmolar water 1 ischaemic gut. A double 4011 has almost completely been replaced by ultra contrast barium swallow has a sensitivity of 1 sound. It may occasionally be needed in patients 75 to 90% in diagnosing re ux oesophagitis 2 in whom ultrasound has failed usually due to depending on the severity. This may be due to neuromuscular 9 Barium Swallow disorders, tumour, pharyngeal pouch or diver 5011 ticulum. The patient is turned to achieve 9 a liquid or solid bolus through the oesophagus. An intravenous 1 wave which may dissipate in the mid oesopha injection of a smooth muscle relaxant 2 gus. Elderly 5 mm in size are more likely to be detected 7 patients usually have minor dysmotility which on barium study than smaller ones. Patients may demon cannot con dently distinguish between benign 9 strate a normal liquid swallow, in which case the and malignant ulcers but may be very suggestive 2011 examination should be continued with a solid (Figure 22. Complete obstruction, sus 6 agents should be used if there is any risk of aspi pected perforation unless a water-soluble con 7 ration. Small bowel contrast studies are better per 1 Unfortunately, mucosal detail is poorly seen formed as a dedicated study rather than a study 2 with water-soluble contrast agents and there following a barium meal. The relaxant given for 3 fore barium is the contrast agent of choice for a barium meal will hinder the passage of barium 4 routine examination of the gut mucosa. An optimal study is 5 dynamic and involves regular uoroscopy to 6 Barium Meal assess mobility of small bowel loops and take 7 spot views of possible pathologies with com 8 Indications. Although direct enteroscopy is developing, 5011 barium radiology of the small bowel remains the 1 Contraindications. Complete large bowel main method for evaluation of this segment of 2 obstruction, suspected site of perforation. Gastric ulcers on barium meal: Classic gastric ulcer 8 pre-treatment (a) and post-treatment (b). Aspiration, perforation of the 4 Malignancies such as adenocarcinoma or lym bowel by the guide-wire. A ne Small Bowel Enema 1 catheter is inserted into the ori ce of the sinus 2 or stula and contrast medium injected with Indications. To investigate the bowel proximal duced into the duodenum and advanced to 2011 to a colostomy or ileostomy. Diluted barium is then the tip of a Foley catheter is introduced a few 2 run in quickly or barium followed by methyl centimetres into the appropriate stoma and the 3 cellulose for a double contrast effect. Barium is run into the 4 are taken of the barium column and its leading bowel and spot lms are taken as required. Cross-sectional Imaging 3011 Radiologists are divided, however, as to which 1 technique is the best. It 4 may therefore have a limited use in the obese 5 patient, in patients who have free gas within the 6 abdomen or who have gaseous distension of 7 bowel loops. Gastric cancer manifest as irregular hourglass-type stricture on barium meal (a) and marked wall thickening on 311 ultrasound (b). It will therefore 9 indications: show as an isolated focus of activity in the right 3011 1 2 3 4 5 6 7 8 9 4011 1 2 3 4 5 6 b 7 8 Figure 22. The results are dis plained nausea or vomiting, autonomic dys 2 played as time activity curves for each third of function or oesophagitis. There is a wide normal 6 range and dif culties may be encountered in 7 de ning the position of the ileocaecal junction. Necrotic 5 tumour in the liver is manifest as cold lesions in the superior 6 segments. However, the underlying principle 2 diagnosis of motility disorders in patients with remains constant. Times are of the order of 12 to 6 relief these should be discontinued 24 hours 13 seconds for the upper limit of normal. Some investigators believe In addition, an assessment of the time taken 3 the sitting position to be more physiological. However, upper limits of normal are 5 domperidone) between 18 and 20% (the position and method 6 Cisapride Antidepressant drugs with of testing will affect this, and normal ranges will 7 anticholinergic need to be determined). A sig ryngeal pouches responsible for this (Figure 8 ni cant correlation between the results of the 23. Transit time was calculated from the time of entry of 10% of peak radioactivity into the 2 esophagus to 90% clearance of peak counts, esophageal retention calculated at the end of 40 swallows (10 minutes) and dubbed E-40. However, gastric recon 1 structions function as well as normal stomachs 2 Myotomy and pneumatic dilatation are recog [13, 14]. Stein, Jorg Theisen and Jorg-Rudiger Siewert 1 2 3 4 5 6 7 8 9 2011 esophageal adenocarcinoma. In contrast to squamous cell esophageal 3 cancer, the incidence of esophageal adenocarci 4 noma has risen exponentially during the past Classification of 5 two decades. At many institutions in Europe 6 and the North America esophageal adeno Esophageal Cancer 7 carcinoma now outnumbers squamous cell 8 esophageal cancer. The marked differences 3 between squamous cell carcinoma and adeno In many centers the topographic classi cation 4 carcinoma of the esophagus in terms of patho of esophageal cancer according to its location 5 genesis, tumor location, tumor stage at the time in the proximal, middle and distal third of 6 of presentation, tumor biology and characteris the esophagus has been abandoned. This facilitates the selec 311 not be applied uncritically to patients with tion of the treatment strategy. The pattern arise from within the esophagus, and thus 6 of lymphatic spread appears to have its water require treatment as esophageal cancer, they 7 shed at the level of the bifurcation: the direction need to be differentiated from other tumors 8 of lymphatic ow is primarily to the upper arising at or below the esophagogastric junc 9 mediastinum and cervical region in patients tion. The chance 5011 of achieving a complete tumor resection is 1 dependent on the histology and the pT category 2 Figure 24.

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It is a prophylactic agent so treatm ent should begin before the pollen season starts and continued throughout. There are no speci c cautions or contraindications, and it does not interact w ith other drugs. Sym pathom im etic decongestants Drops and sprays containing sym pathom im etic decongestants are used to relieve nasal congestion associated w ith hayfever, and m ay be useful to begin treatm ent w hen the nose is badly blocked. All exert a rapid and potent vasoconstricting effect w hen applied directly to the nasal m ucosa. M ost eye sym ptom s relating to hayfever w ill be controlled by oral antihistam ines, but if sym ptom s are persistent or particularly troublesom e, eye drops are usually effective. The latter has vasoconstrictor action and is included as a conjunctival decongestant. This preparation can be used for the short-term treatm ent of hayfever sym ptom s, but prolonged use m ay raise intraocular pressure and precipitate glaucom a. The drops are used tw ice or three tim es daily and are suitable for children from 5 years of age. All eye drops for allergic conjunctivitis contain the preservative benzalkonium chloride, w hich is absorbed into soft contact lenses and released onto the cornea during w ear, causing in am m ation and irritation. Soft lenses should not be w orn w hile using these products; gas-perm eable lenses m ay be inserted 30 m inutes after using the eye drops. Additional advice Stay indoors and keep all w indow s closed (this reduces pollen exposure by a factor of up to 10 000). Hayfever 153 W ear close tting sunglasses w hen outside, and a m ask if sym ptom s are really severe. Self-assessm ent Case study It is mid-summer and you are consulted by a young woman wanting advice about her hayfever. She tells you that she is about 18 weeks pregnant and is experiencing really bad hayfever symptoms. She has been prescribed desloratadine tablets by the obstetrician at the antenatal clinic but they do not relieve all the symptoms. She has a lot of discomfort: her eyes feel very itchy and her nose is permanently blocked. Addictive effects of nicotine Nicotine is readily absorbed through the oral m ucosa and the lungs. Peak blood concentrations are achieved w ithin 30 seconds of a puff of a cigarette. The drug acts on the central nervous system, causing transient euphoria, a feeling of relaxation, im proved concentration and m em ory and reduced appetite. W ithdraw al sym ptom s are anxiety, dif culty in concentrating and irritability, w hich are relieved by the next cigarette. Eventually sm okers establish a steady blood concentration of nicotine through a regular sm oking pattern, preventing w ithdraw al cravings. Psychological and behavioural com ponents contribute to sm oking dependence in about equal m easure to physiological addiction, and are of tw o types: 1. The cost to the National Health Service of treating sm oking-related diseases is around 1. Nicotine plasm a concentrations from patches are about half those obtained from sm oking the average num ber of cigarettes per day. All brands are available in three strengths, providing a sm ooth reduction in nicotine intake. The recom m ended starting strength is generally the highest, except for light sm okers, for w hom the m edium strength should be used rst. Peak blood concentrations are reached in about 2 m inutes and the contents of a piece of gum are intended to be released over about 30 m inutes. A piece of gum is chew ed w henever there is an urge to sm oke, and it m ay be the m ost suitable m ethod for the sm oker w ho nds cigarette cravings dif cult to resist. It m ay also provide a greater sense of control over curbing the habit, and chew ing acts as a behavioural substitute for sm oking. Use of gum m im ics the pattern of nicotine intake obtained by sm oking, but peak blood levels are low er and the steady-state nicotine concentration is about 30% of that obtained from cigarettes. Inhalator Nicotine is contained in an im pregnated porous polyethylene plug inside a plastic tube, and is used in the sam e w ay as a cigarette, w ith puffs taken as desired. But a plug w ill last m uch longer than a cigarette because the available nicotine is released over about 20 m inutes, and not only is nicotine intake reduced but the concentration peaks are also attened. Nicotine intake is slightly higher w ith the form er, but both m ethods produce com parable steady-state plasm a concentrations equivalent to those achieved w ith nicotine gum. Sublingual tablets Sublingual tablets provide an unobtrusive m ethod of nicotine replacem ent. One sublingual tablet is bioequivalent to one piece of nicotine 2 m g chew ing gum, and the recom m ended dosage is com parable. It m ay be a useful m ethod for sm okers w ho do not like or have dif culty in chew ing gum. Depending on how heavily a person sm okes, one or tw o tablets are used per hour to an absolute m axim um of 40 per day. The full dosage should be m aintained for 3 m onths and then gradually reduced to zero w ithin the next 3 m onths. Nasal spray this provides a fast-acting m ethod of nicotine delivery for highly dependent sm okers. One m etered spray is inhaled into each nostril w hen necessary to relieve craving, w ith a m axim um tw o doses per hour and 64 sprays (32 into each nostril) in 24 hours. As-required dosing can be m aintained for up to 8 w eeks, after w hich the dosage should be reduced to zero over the next 4 w eeks. Side-effects, including nose and throat irritation, w atering eyes and coughing, are fairly com m on, especially in the rst couple of w eeks. Lozenges As w ith chew ing gum, nicotine is absorbed from lozenges through the buccal m ucosa. Sm okers w ith any chronic or serious skin condition should avoid patches as there is a possibility of localised skin reactions. Nicotine can exacerbate sym ptom s of peptic ulcer or gastritis, particularly w ith gum or lozenges, as nicotine m ay enter the stom ach directly. Interactions Tobacco sm oke reduces serum levels of a w ide range of drugs and dose adjustm ent m ay be necessary w hen sm okers have given up, particularly w ith theophylline, beta-blockers, adrenergic agonists, nifedipine, tricyclic antidepressants, phenothiazines, benzodiazepines and insulin. He says he has been looking up smoking cures on the internet and found articles on several sites that say Zyban is very effective. He wants to know if it is as good as the articles say it is, and if he can buy it from you because he would rather you had the business. Tips For calculation questions in the registration exam, it is essential to understand thoroughly and be able to manipulate concentrations expressed in percentages, proportions and parts and as molar quantities. Skin Acne 163 Cold sores (oral herpes sim plex) 169 Eczem a/derm atitis 173 Fungal skin infections 179 Scalp conditions 183 chapter 25 Acne Acne vulgaris is a com m on condition in young people. Although it m ay som etim es be unsightly and can persist for several years, it is not usually serious and resolves in m ost patients by the age of 25.

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H and can b e rotate to allow asy vi wing of m od l rom allangl sand can b e re m ove i ne ce ssary. Strate gicallyb uilt in m agne tshlpgui th asse m b lyasstu ntsl arn ab outth intricate f ature sof th ind ivi ualb one sand thir articulations. Nevertheless they always stay in Natural casting of a human foot fexible mounted on wire. The foot is 6 movable mounted on rubber and the rolling motion can therefore be demonstrated admirably. The foot is movable mounted on rubber and the rolling motion can therefore be demonstrated admirably. W itha ootm ounte on rub b e rb and to allow an d fexi bl e foot, w th usc e ar g d m onstration of th rolling m ove m nt. W itha ootm ounte on rub b e rb and to allow d m onstration of th rolling m ove m nt. Footcan b e re m ove and S ze x x m t: place on th stand upsi own to acilitate ef o. 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W ithke ycard 1 espi ratoryorgan s ardi opul on arysystem S ze x x m A li size m od l fne lycolore to show allm ajor i size m od linclu slungs, tracha, hart, anatom ical tail h iaphragm showsm uscl s, sophagus, and com pl the larynx withvocalcord s, ef o. Stu ntscan se and l arn how lungs, thatare ve rycom parab l withthirown, work b yinfating and fating thm witha pum p. Suppl m ntal inf orm ation ab outlung cance r othrsm oking ind uce ise ase s, and airpollutantsisalso inclu T h infatab l swine lungshave b e n staine re alisticallyand thn spe ciallypre se rve b yth B ioFl x od orl ss, nontoxic proce ss thatre tainsth the xture and lasticityof re shlungs. H artm uscl attytissu arte ri sand ve insare painte in tail;th structure sare shown on th ucationalcard (rm an/ nglish h m od lism ad of unb re akab l plastic and re m ovab l f rom th stand S ze x x m t: ef o. H artm uscl attytissu arte ri sand ve insare painte in tail th cond ucting syste m ism arke in color h m od lism ad of unb re akab l plastic and re m ovab l rom th stand 3 S ze x x m t: ef o. R prod uce se ctions: xte rnal lum inalsurf ace s) rightatrium U sesofth e odel: l tatrium rightve ntricl l tve ntricl aorta supe rior sim ulator orpractice in coronaryarte ryb ypassgraf ting or inf riorve na cava pulm onaryve in coronaryarte ry ve ins othrsurge ry (lum inal m itralvalve tricuspi valve aortic valve pulm onary cathte rization sim ulator coronaryarte ri snothollow) valve papillarym uscl coronarysinus ucationalm od l orl arning surge ryskills. R prod uce se ctions: xte rnal lum inalsurf ace s) rightatrium U sesofth e odel: l tatrium rightve ntricl l tve ntricl aorta supe rior sim ulator orpractice in coronaryarte ryb ypassgraf ting or inf riorve na cava pulm onaryve in coronaryarte ry ve ins othrsurge ry (lum inal m itralvalve tricuspi valve aortic valve pulm onary cathte rization sim ulator oronaryarte ri snothollow) valve papillarym uscl coronarysinus ucationalm od l orl arning surge ryskills. Fourcrossse ctionson th b ase show throughth vascularwallwithintim a, m ia and ad ve ntitia. K2 3 K i dn ey odel K i dn ey odel T hism od lof a hum an ki ne yin alm ostli ti es fe si ze size showshand painte tailsof re nalpe lvis, hism od lof a hum an ki ne yin ab out re nalm ulla, re nalcalyx, re nalcorte x, re nal tim sli size showshand painte tails arte ryand ve in, ure the rand ad re nalgland W ith of re nalpe lvis, re nalm ulla, re nalcalyx, e ucationalcard and stand re nalcorte x, re nalarte ryand ve in, ure the r S ze x x m t: and ad re nalgland W ith ucationalcard and stand ef o. K2 6 4 1 1 ter al rgan s, part Pan creas an d duoden um T h organsare shown partiallyope ne hisli size m od lisan accurate and th gallb lad risre m ovab l withpart re pre se ntation of th pancre asand uod num of th live r h pancre asisope n to show th ntire I tdepi cts: pancre atic uct. K2 K i ne ys re nalgland s 1 B lood ve sse ls M ounte on wood n stand S ze x x m ef o. W 3 verw th gal bl adder pan creas an d duoden um T hisli size m od lshowsa se ction of th live r withgallb lad r pancre asand uod num; inclu shpatic and pancre atic ucts. K4 4 4 seases ofPan creas, Spl een an d al bl adder 3 T his ullsize m od lshowspancre atic cance r th gallb lad rwithstone s, a rupture spl n and d uod num withan ulce r ef o. K2 1 4 1 al ston e odel T hishal naturalsize m od lshowsth anatom yof th b iliarysyste m and istsurround ingsin gre at tail B oth th tissu change scause b ychronic infam m ation and acute infam m ation chol cystitis) are re pre se nte in th gallb lad rwall allstone sare shown in th ollowing typicalplace s: spiralvalve und usof th gallb lad r com m on b il uct 3 papillaryope ning to th sm allinte stine 1 M ounte on b ase ef o. K2 6 3 Segm en tal ver T hisre uce size m od lshowsth ivision of th live rinto live rse gm nts af the r ouinau t xplainsth se parate ve sse lsupplyof th ind ivi ual se gm nts. T h efol ow g segm en tsaredepi cted: 2 ver odel w th gal bl adder 2 t ive r ob e ight ive r ob e T hisre alistic m od lre prod uce sa live rwithth gallb lad r h Se gm nt cau ate lob e Se gm ntV cau alpartof ante rior hilusve sse lsare shown aswe llasth xtrahpatic uctsand th Se gm nt cranialpartof late ral se gm nt m ain ligam nts. K7 9 a singl live rlob ul whichisse ctione and shown in re lationshipto portionsof surround ing lob ul s. K78 1 5 1 2 3 1 um an di gesti ve system parts Stom ach fe si ze, parts esoph agus seases T hisli size m od lshowsth hum an ige stive tract rom hisli size m od lis isse cte along th m ialplane hisli size m od lshowsa rontalse ction of th lowe rpart m outhcavityto re ctum h oralcavity th pharynx and and can b e ope ne to show th inte rnalstructure of th of th oe sophagusand th uppe rpartof th stom ach th frstpartof th sophagusare isse cte along th stom achinclu ing th card ia, th m ucosa and th pylorus. K2 1 6 1 3 2 1 Stom ach w th U cers Stom ach odel w th gastrcban d aem orrh oi ds odel T hisre uce size m od lshows i re ntstage sof gastritis hisstom achm od lin li size showsth unction of a his scriptive m od l orpati nt ucation in ab out starting rom lightulce rand nd ing in pe rf oration. K8 re pre se nte rosive gastritis rythm atousgastritis ze x x m H aling stage withscar orm ation ef o. K2 7 B l ing ulce r Pe rf orate ulce r O n Stand S ze sto m x 9 x 2 m ze ro ss se ti x 3 x 1 m W t: ef o. K2 7 1 7 3 2 1 1 ol on odel w th di seases Vi us en arged, parts testi al Vi ti es fe si ze R uce size m od lof a hum an colon showing il um hisgre atly nlarge partm od lof a villus rom th sm all his tim sli size m od lconsistsof one ntire villus, cae cum asce nd ing colon, transve rse colon, sce nd ing inte stine shows tail rom a transve rse and longitu inal one longitu inallyse ctione villusshowing th arte riol s colon, sigm oi colon and re ctum h ollowing ise ase s se ction. K2 1 1 U rogen tal rgan s, Fem al e L i size withpe lvisand fve lum b arve rte b rae with 1 ligam nts, pe lvic foor uroge nitalorgans, ki ne ys, ure the rs and ab d om inalaorta. K3 2 2 Fem al e bl adder T hism od lof a m al b lad rin ab outli size showsall anatom icalstructure sascrossse ction. B lad r ure thra and sphincte rare cl arlyvisib l Pe rf ctaspati nt ucation tool or pe lvic foortraining. Naturalcasting of a m al pe lvis cord cl arlyshowsth ve in and arte ri sand withli size oe tus ollm ad of clothplastic had om sin carrying b ag. T h Place nta/ ord m nion/ horion od lallowsth Fe tal M od lto b e shown insi a sim ulate am niotic sac. B yad ing orre l asing air th sim ulate q uantityof am niotic fui can b e ad apte to th sire cond itions.


  • Starvation
  • Splenic artery aneurysm (rare)
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  • The condom should be in place from the beginning to the end of the sexual activity. Use it every time you have sex.
  • Start introducing new tastes, especially green vegetables, beginning at 6 months, in the form of baby food.
  • Get a blood test early in the pregnancy to see if you are immune to rubella. If you are not immune, you must avoid any exposure to rubella and should get immunized right after delivery.
  • Reactions to anesthesia medicines
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All mothers that may bleed after or during delivery can be identified during antenatal follow up. Ninety nine percent of these deaths are estimated to occur in developing countries. It is one of the major causes of maternal death in both developing and developed countries. As a result of poor health care system in the developing countries, maternal bleeding has more disastrous impact on maternal mortality and morbidity than that of developed countries. Like other causes of maternal deaths, maternal death due to maternal bleeding is preventable if locally available resources and appropriate techniques are used effectively during pregnancy, labour /delivery and postpartum care of a woman. Thus, based on the above mentioned facts, this module is intended to help, the health team working at the rural areas, where most cases of maternal deaths occur, to acquire the basic knowledge and skills about causes & strategic interventions to control and prevent maternal bleeding that contributes significantly in the effort done to reduce the prevailing high rate of maternal mortality and morbidity in the nation. Abortion alone constitutes one of the five leading causes of maternal death in the developing world. Globally, unsafe abortion claims the lives of 200 women daily, or 78, 000 women yearly of these 34, 000 are women African accounting 44% of the global figure. One community based study done in Ethiopia revealed that abortion accounts for 32% of direct cause of maternal mortality. The most common site is fallopian tube (in greater than 90% of cases) ii) Abortion: It is a uterine bleeding before fetal viability, i. Inevitable: abortion with cervical dilatation but with out expulsion of products of conception (including amniotic fluid) 2. Missed: when a dead fetus retained in the uterus at least for another one month. Habitual (recurrent): is diagnosed if there is three or more consecutive spontaneous expulsion of conceptus. B) Bleeding in late pregnancy and labour i) Heavy show: is Blood-stained mucus that herald onset of labor. Unknown Causes: In many of cases no causes is found clinically or by investigation. Atonic Uterus: bleeding occur due to failure of contraction and retraction of the uterus. Tears of Cervix, Vagina or perineum that occurred during difficult vaginal delivery. Retained placenta is diagnosed if placenta is not delivered within 30 minutes after delivery of term fetus. Bleeding after 28 weeks of gestation that may be precipitated by intercourse, relaxed uterus, lower uterine pole feel empty, bleeding May be light or heavy but painless, shock, fetal condition depends on the severity of maternal bleeding. Placenta abruption: is due to premature separation of normally implanted placenta. Bleeding occur after 28 weeks, and it is usually dark oozing vaginally or may be retained in the uterus, Intermittent or constant abdominal pain, tense /tender uterus, fetal movement decreased or absent, fetal distress or absent fetal heart sound. Sometimes, a significant amount of blood can be retained in the uterus behind a partially separated placenta /membrane or blood may collect in an atonic uterus. Thus, strict monitoring of uterine size and tone is crucial following delivery of placenta. If the cause of bleeding is not uterine atony, then blood loss may be slower and clinical features of hypovolemia may develop over a longer time frame. Symptoms of hypovolemia may not develop until a large volume of blood has been lost because most women giving birth are healthy and compensate for blood loss very well Most common delivery position (semi-recumbent) with the leg elevated masks the actual loss. The major factor in the adverse outcomes associated with severe hemorrhage is a delay in initiating appropriate management. Degree of blood loss is divided into 4 (four) classes depending on the amount of volume deficit. Class I Blood loss of less than or equal to 900 ml Or Volume deficit of less than or equal to 15 % is asymptomatic. Specific management of common etiologies of maternal bleeding is listed in the satellite module. The most common causes are hemorrhage, including uterine rupture, obstructed labour, unsafe abortion, puerperal infection, and eclampsia. Underlying these medical causes are the socio economic, geographic and cultural factors. However, health professionals including nurses often fail to take appropriate and timely action when there are actual or potential risks of maternal bleeding. This again makes it difficult to reduce the mortality and morbidity from this major problem. This satellite module is designed to strengthen the contribution of nursing students and other staff nurses in the management of maternal bleeding. The major points regarding maternal bleeding are described in the core module and activities specifically geared to nursing are highlighted here. Effort was also made to incorporate the nursing assessment and nursing diagnosis for common causes of maternal bleeding. Case studies and study questions are also incorporated in order to create an interactive learning approach. Other complications that can cause bleeding in the first half of pregnancy are: Cervical conditions (Cervical Ca, polyps, cervicitis and erosion). Maternal Febrile illness Syphilis Hypertension Diabetes Classifications of Abortion 1. Spontaneous-Threatened v Missed abortion May go to term Inevitable abortion (may be either complete or incomplete) Recurrent /habitual abortion 2. Induced Therapeutic Non therapeutic (safe/ usually unsafe, leading to septic abortion) Spontaneous abortion Is an abortion which has not been interfered /happens spontaneously. Causes: About 50 % of early spontaneous abortions are related to chromosomal abnormalities. S/S of threatened abortion include: Slight vaginal bleeding Slight backache Cervix closed. Despite the above management if bleeding persists it suggests inevitable abortion. Cause Cervical incompetence due to weakness or repeated D & C It can also be caused by chromosomal abnormalities Obstetric Management Shirodkar stitch. The stitch should be removed at term (at 38 weeks of gestation) Unsafe Abortion: Definition: is an abortion procured by unskilled person or in an environment where aseptic technique is lacking. In our setup, it is usually performed illegally for the sake of benefits or favor. Proliferated trophoblast become filled with fluids and collectively looks like a bunch of grapes; fetus dies and is absorbed inside the trophoblast but the villi continue to multiply that enlarges the uterus greater than the gestational age. It is an implantation of the placenta at or near the cervix and is bleeding from abnormally situated placenta the placenta is situated wholly or partly in the lower uterine segment and lies either anterior or posterior. Sudden decompression of the uterus in case of rupture of membranes in a patient with polyhydramnious. Revealed/mild, slight vaginal bleeding, fetus is alive and maternal condition is good. Concealed, all bleeding retained behind the placenta/ retro placental clot, and some blood infiltrate b/n the uterine muscles causing bruise and edematous; called couvelaire uterus or uterine apoplexy.

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Bacteremia or secondary bacterial pneumonia, however, is unusual in patients with bronchiolitis. With the possible exception of atelectasis, the chest radiograph findings do not correlate well with the severity of the disease. Apnea in patients hospitalized with bronchiolitis has ranged from 3% to 20% in studies. If none of these clinical criteria are present, the risk of apnea is less than 1%. Although corticosteroids have been used by clinicians for many years for the treatment of bronchiolitis, the preponderance of multiple controlled studies has shown no immediate or long-term advantage with their use, either by the systemic or inhaled route. Nebulized epinephrine (with both a and b-adrenergic action) may be more effective than b2-agonists such as albuterol. In infants with significant wheezing, a trial of a bronchodilator therapy may be considered. Continuation of bronchodilators should be based on a positive clinical response using an objective means of evaluation. In more severe cases, the value of bronchodilators and corticosteroids is controversial. Primary infections tend to be the most severe episodes, with subsequent illnesses being more muted. In follow-up studies, 40% to 50% of these infants have subsequent recurrent episodes of wheezing, usually during the first year after illness. The question of whether the pulmonary sequelae are the result of the bronchiolitis or of a genetic predisposition to asthma remains unclear. Factors such as pulmonary abnormalities before the illness, passive cigarette smoke exposure, atopic diathesis, and immunologic responses of virus-specific IgE determine the risk for recurrence. The most common complaints relate to poor self-image and decreased exercise tolerance. Counseling is often sufficient for the cosmetic aspects, but many older patients report an improvement in exercise tolerance following repair, Figure 17-1. Whether the reason is cosmetic or to improve maximal exercise, operative repair should be delayed until the child is older than 16 years to decrease the risk for recurrence during the pubertal growth spurt. Postnasal drip (also known as upper airway cough syndrome) and asthma and asthma-like symptoms. The differential diagnosis of chronic cough is very long and includes congenital anomalies, infectious or postinfectious cough, gastroesophageal reflux, aspiration, physical and chemical irritation, and psychogenic cough. After a thorough history and physical examination, evaluation with a chest radiograph and spirometry can also help to establish the diagnosis. A psychogenic cough should be considered in children with a persistent dry, honking, explosive daytime cough that disappears with sleep or at the weekend. Behavior management is the preferred treatment, although, in some cases, psychological intervention is required. Multiple studies have failed to show benefit over placebo of any particular medication, including dextromethorphan, diphenhydramine, codeine, and echinacea. In addition, because the use of over-the-counter cold and cough products with antihistamines and decongestants have been implicated with many adverse events, a U. Food and Drug Administration advisory committee has recommended against their use in children younger than 6 years. Many manufacturers have voluntarily removed such products intended for children younger than 2 years. Supportive care with patience and self-resolution of symptoms (tincture of time) remain the mainstay of treatment. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2007, Available at. Digital clubbing is the presence of increased amounts of connective tissue under the base of the fingernail. A, Normal child with a diamond-shaped window present between the nail between the nail bases when the fingers are opposed. The increased connective tissue under the nail beds that causes digital clubbing may be caused by the presence of vasoactive substances that are increased because of hypoxia; increased production in chronic inflammatory disease; or decreased lung clearance. About 3% of children with cystic fibrosis have nasal polyps, which are often a recurrent problem. A patient with chronic sinusitis and recurrent pulmonary infections has a chest radiograph that demonstrates a right-sided cardiac silhouette. Bronchial or nasal turbinate mucosal biopsy for electron microscopic evaluation of cilia. Kartagener syndrome is one of the ciliary dyskinesia (or immotile cilia) syndromes. The presenting symptoms are a constellation of recurrent pulmonary infections, chronic sinusitis, recurrent otitis media, situs inversus, and infertility (in males). Structural ciliary abnormalities (most common are absent dynein arms) result in abnormal ciliary beat frequency and decreased clearance of respiratory secretions, thereby predisposing the patient to infection. In addition, because spermatozoa have tails with the same ultrastructural abnormalities as respiratory cilia, they move less well, causing infertility. Between 5% and 10% of preadolescent children are reported by their parents to snore at night. During the day, there may be excessive daytime sleepiness, learning problems, morning headaches, or personality changes. Less commonly required are videofluoroscopy of the upper airway, computed tomography, or magnetic resonance imaging. It is strongly implicated in the development of hypertension, ischemic heart disease, arrhythmias, and sudden death (in individuals with coexisting ischemic heart disease); it also contributes to the risk for stroke. Congenital laryngomalacia occurs as a result of prolapse of the poorly supported supraglottic structures: the arytenoids, the aryepiglottic folds, and the epiglottis. Stridor is loudest after crying or exertion, but it typically does not interfere with feeding, sleep, or growth. How can you clinically distinguish bilateral from unilateral vocal cord paralysis in an infant Normally, the vocal cords are tonically abducted, with voluntary adduction resulting in speech. With unilateral paralysis, one cord is ineffective for speech, and hoarseness results. With bilateral paralysis, hoarseness is less apparent, and the cry remains weak, but stridor (both inspiratory and expiratory) is usually quite prominent; in addition, the infant is more likely to have frank symptoms of pulmonary aspiration. These are vocal cord nodules caused by vocal abuse, such as repetitive screaming, yelling, and coughing. They are the cause of a hoarse voice in more than 50% of children when hoarseness persists for more than 2 weeks. Symptoms and history n Child less than 4 years old n Boys twice as common as girls n Coughing n Hemoptysis n Respiratory infection not resolving with treatment n History of choking n Difficulty breathing Signs n Fixed, localized wheeze n Wheezing in a child who has no history of asthma n Reduced breath sounds over one lung, one lobe, or one segment n Mediastinal shift n One nipple higher than the other as a result of unilateral hyperinflation n Stridor 68. Features suggesting a foreign-body aspiration are as follows: n Expiratory chest radiograph showing asymmetry in lung aeration as a result of obstructive emphysema (the foreign body often acts as a ball-valve mechanism, allowing air in but not out) n Right and left lateral decubitus films that show the same asymmetry (these views are often used in uncooperative children who cannot or will not exhale on command) n Obstructive atelectasis 69. What are the possible mechanisms for the development of lung abscesses in children Bronchiectasis is the progressive dilation of bronchi, most likely from acute and/or recurrent obstruction and infection. Clinical findings can be variable but usually include persistent cough, chronic production of purulent sputum, recurrent fevers, and digital clubbing. A novice teenage mountain-climber develops headache, marked cough, and orthopnea at the end of a rapid 2-day climb.

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These come in many forms, but tablets are Misoprostol can be used to prevent or control cheapest and work well. Injections of vitamins are heavy bleeding after childbirth, and control heavy rarely necessary, are a waste of money, cause bleeding from miscarriage or abortion. Be sure the tablets used contain the cheek or under the tongue and then swallow all the important vitamins (see p. If the woman is feeling nauseous, you can also put the tablets up her anus Using standard tablets of mixed vitamins, to dissolve there. There are many different price: for preparations. Diets to soften stools are important For prevention: In areas where night blindness (see p. The In 1 cup of boiled water, put: next day give 1 vitamin A capsule (200, 000 units) by 12 level teaspoons of powdered milk, mouth, and another capsule 1 to 2 weeks later. Usually 2 weeks treatment is enough for Often comes in: tablets of 200, 325, or 500 mg. Treatment with ferrous women who are anemic and malnourished would sulfate by mouth usually takes at least 3 months. If be helped by taking folic acid and iron tablets daily improvement does not take place, the anemia is throughout pregnancy. Ferrous sulfate is especially important adults and children over 3 years: for pregnant women who may be anemic or 1 tablet (5 mg. For children under 3 years, a piece of a that is almost never found except in some persons tablet can be ground up very fine and mixed with over 35 years whose ancestors are from northern the food. Keep tablets out of Do not waste your money on vitamin B12 or let a the reach of children. Do not give ferrous sulfate to doctor or health worker give it to you unless a blood severely malnourished persons. In each dose give: Name: Price: for adults and children over 12: 1 tablet Often comes in: ampules of 1 mg. Do not inject more, even if the bleeding Name: price: for continues. Folic acid can be important in the treatment of Vitamin K is of no use to control bleeding of the kinds of anemia in which blood cells have been mother after childbirth. An anemic person who has a large spleen or looks yellow may need folic acid, especially if his anemia does not get much better with ferrous sulfate. Or the Brevicon 1+35 Ovysmen 1/35 vitamin can be given only to persons who develop Noriday 1+50 Neocon problems because of its lack. Signs include pain Norinyl 1+35, 1+50 Norimin or tingling in the hands or feet, muscle twitching, Ortho-Novum 1/35, 1/50 Perle nervousness, and being unable to sleep. The following information is about choosing To assure effectiveness and minimize spotting the right pill for individual women. If someone you are working with has an time each day, especially with pills that have low older version of the book, be careful not to confuse amounts of hormones. If there is still spotting after 3 months, try a brand Most birth control pills contain 2 hormones from Group 4. These hormones As a rule, women who take birth control pills are called estrogen and progesterone (progestin). This may be a the pills come under many different brand names good thing, especially for women who are anemic. A few of the brand names are listed in months or is disturbed by the very light monthly the groups below. Usually, brands that contain a smaller amount of both hormones are the safest and work best for For a woman who has very heavy monthly most women. Since the amounts change, it is important to using another type of pill, can change to a pill that take the pills in order. Using birth Denoval Nordiol control pills this way is safe, even for many women Eugynon Ovral who should not use pills all the time. Femenal Primovlar Dosage: Emergency pills must be taken within 5 days Neogynon of unprotected sex. The sooner you take the pills If spotting continues even when taking pills from after unprotected sex, the more likely you will not get Group 4, the brands Ovulen and Demulen will often pregnant. But these are very strong in estrogen and so follow these instructions: are rarely recommended. There is also New emergency pills have been developed an increased chance of pregnancy if even a single just for emergency family planning and may be pill is forgotten. With Postinor-2, for example, which Microlut Neogest contains only progestin, you take 1 pill within 5 days Micronor Neogeston of unprotected sex, followed by 1 more pill 12 hours Micronovum Ovrette later. Nor-Q D Side effects: these brands Less than half of all women who use emergency can also pills will have nausea or vomiting. If vomiting occurs be used for within 3 hours after taking the pills, another dose Emergency must be taken. Or, instead of taking the emergency pills by section mouth you can place them high in the vagina. It does not reduce the side effects of nausea or vomiting, but it does prevent you from vomiting the pills. Women who have heart problems, blood clots or strokes should use Name: price: progestin-only pills. The most common side Condoms (rubbers, prophylactics, sheaths) effect is heavier, longer and more painful monthly Name: price: for bleeding, but this usually stops after the first 3 months. If this happens, it will not be effective in preventing There are many different brands of condoms. Many people use condoms along with another the strings, she should wash her hands well and form of birth control. The diaphragm is most effective when used Pelvic inflammatory disease is the most serious with a spermicide cream or jelly. Most the diaphragm, and also spread some on the rim infections happen in the first 3 months, usually before putting it in the vagina (see p. Emko, Lempko, Delfen) Name: price: Injectable contraceptives For discussion of the use of foam, see page 290. The Name: price: hormones also make the mucus at the opening of this is a tablet containing spermicide that a the womb very thick, which helps stop the sperm woman puts deep in her vagina near her cervix. It is a fairly effective method of birth control, these are especially good for women who should especially if the couple also uses a condom. She will probably stop having monthly bleeding by Medicines called antiretrovirals can help people the end of the first year. If she stops having injections and that they are becoming unable to fight illnesses well does not want to become pregnant right away, she (see p. This the mucus at the opening of the womb very thick, may affect what medicines you should which helps stop the sperm from getting inside the take now. Jadelle has 2 tubes and prevents Do you know about the benefits, risks, and pregnancy for 5 years. During the first year, implants may cause irregular Are you able to take medicines every day, at bleeding or more days of monthly bleeding.

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Many people have become dependent on the the psychic and physical dependency to caffeine. Unfortunately, is generated through roasting the outer part, or exocarp, of caffeine does have its negative effects, including the possibility green and dried fruit. After they become almost black, they are of addiction, but research is being done to see what else it ground up. It is a powder that can be taken orally or arabica has provided the world with a stimulant that is used applied topically. One dose of Coffea carbo is generally about 3 daily, not only for general stimulation but also medicinal grams, and the daily dose is about 9 grams (for internal use) purposes. Coffea arabica: A wonder gift to activities of medicinal plants traditionally used in the village medical science. Retrieved catecholamines and blood pressure compared to March 8 2012 performance variations. New York: Food of chronic coffee drinking on blood pressure: a meta Products Press. Association of coffee Common Natural Ingredients: Used in Food, Drugs and and caffeine intake with the risk of Parkinson disease. Originally given the name Sterculia nitida by the French, it was later decided by the Germans that it belonged in the Cola family. Depending on its global location, it may also be referred to as gbanja kola, bitter kola, bese, goro, bissy or biche, kolatier, or colatero. With over sixteen different species in the Cola genus, the two most common edible types are the C. Having been transmigrated by the slave trade, the kola nut is quite versatile and has been used as a mild stimulant, antidote for specific Figure 1. Cola nitida carpel and flowers: the kola nut can be diseases, a hunger-suppressant, gift to royalty, a token of found inside the carpels, which are the seeds. Image source: peace or war, and even as a dye for decorating cloth (Abaka, english. Used in conjunction with herbal plants such as ma huang and in well-known commodities like Coca-Cola soda, the kola nut has become a major cash crop for its native Botanical Description African countries. Known for its meters in diameter, and is capable of producing light brown astringent taste and high caffeine content, the kola nut carpels that can contain anywhere from one to fifteen seeds; produces a mild stimulating and sustaining effect once allowing a single tree to produce well over a thousand nuts consumed (Brooks, 1980). The carpels are accompanied by flowers that are normally greenish-yellow or white with 156 | M edicinal Plant M onographs Figure 3. Kola Nuts ranging in colors: the variety of color Leone, and the confluences of the Niger and Benue rivers. Image source: However, due to the frequent traveling by man and the rising. Low elevations, well kola nut, which is not a true nut but a seed from a follicular drained soil, and moderate rainfall are needed for the fruit, is roughly the size of a Brazil nut or a chestnut ranging successful growth of C. Because most African countries be found in a wide range of colors varying from a cream/white experience a dry season (December to March), it is important when found fresh to a dark reddish brown when dried to grow C. After 5 days of fermentation, the ripe fruits are 157 | M edicinal Plant M onographs harvested before the follicles are able to split open. Upon nuts that are chosen for cultivation are left to fully mature and learning of its additional medicinal properties, the Islamic ripen. One method used to obtain the maximum yield of the kola nut raw to reduce the effects of fatigue, hunger, and kola nuts, is to cultivate it along with other crops. In 1688, the historian Hans Theobroma cacao can grow in the same climate conditions. Sloane examined the effects of kola nut samples taken from Both species can actually be grown together, with C. He discovered the kola nut could be used as a diuretic acting as an intercrop by providing top shade for T. The kola was also Both species are a part of the Sterculiaceae (now Malvaceae) known to provide cures for headaches and male sexual family, which contain flowering plants and is also known as impotency (Lovejoy, 1980). Now, many African societies see the kola nut as such a high importance in West Africa than the kola nut. During the same century, the kola chewed individually or in a group setting (Abaka, 2005). In nut was documented to help ease the pains of childbirth and certain Nigerian cultures, to be given a kola nut is a great as a treatment for rheumatism and dyspnea. There are special occasions and ceremonies that century, a report stating the existence of an African kola trade encompass the use of or the giving of the kola nut. For Muslims, kola nut was, and still is, a high considered a vital component during the wedding reception. During a christening, a red kola Other Uses represents life and the white kola purity. Also, the breaking of a kola nut is said to be a valued expression of hospitality. Invented by John Pemberton, the original Coca-Cola been used for making furniture, house and boat buildings, drink was made by combing coca and kola extracts with the domestic utensils, musical instruments, and wooden games hopes of concocting a remedy for headaches and hangovers and toys. Both addition to being implemented in soft drinks like Coca-Cola, stimulate the central nervous system and the amounts of each 159 | M edicinal Plant M onographs Stimulant Caffeine (%) Theobromine (%) of the whole tree have been reported to have significant medicinal uses. Elastase Reduction Activity constituent in a kola nut fluctuate from one kola to the next. While caffeine has the stronger presence in a kola nut, Inflammatory diseases like asthma or cystic fibrosis are theobromine has the greater responsibility in stimulating the characterized by excess uninhibited neutrophil elastase, skeletal muscles. A study to the two alkaloids, a glucoside heart stimulant, kolatin, is shows that kola nut extract, depending on its concentration, also present (Lovejoy, 1980). Because of this, one average sized kola nut is equivalent to Aphrodisiac approximately three cups of American coffee, but these effects can vary from person to person. During the eighteenth and twentieth century kola nitida are strychnine, catechin, flavonoids, anthocyanins, consumption in the Hausaland was promoted by the belief quinine, theine, and tannin (Abaka, 2005). The study substituted drinking water with Biological Activity three different kola beverages for three months. At the end of Biological activity is not only present in the kola nut, but parts the study the kola intake increased both oestradiol and 160 | M edicinal Plant M onographs testosterone levels, suggesting that there is an additional (Ajarem, 1990). A later study explained the locomotors mechanism of action beyond the effects of caffeine (Schliep, activity due to the caffeine content while kolanin is 2012). Antimicrobial Ocular Activity An in vitro study examines four human pathogenic bacteria Thirty grams of C. The results show that the presence of healthy volunteers to determine ocular effects. Results secondary metabolites partially enhances the showed no effect on the pupil diameter of visual acuity but chemotaxonomic characterization of C. The kola nut inhibitory activity against Aspergillus niger and Candida extracts allows near work to done without stress. Antioxidant Antibacterial Activity the high levels of phenolic compounds found in kola nuts allow the extract to exhibit antioxidant capacities. Of the secondary metabolites found in kola nut also found in the bark were show to inhibit growth of extracts, caffeine has the most antioxidant capacity proving to Staphylococcus aureus, Pseudomonas aeruginosa, haemolytic be an effective cancer chemopreventive metabolite (Sunday, streptococci, Escherichia coli, and Neisseria gonorrhoeae (Lim, 2007). Firth to test for four properties of a kola nut: activity increased while low doses showed no effect and high whether a person could undergo long periods of fasting and doses resulted in a depressive effect of locomotors activity fatigue without exhaustion, adjuvant to sustain the body 161 | M edicinal Plant M onographs during exertion without food, restore a person in the drunken for recuperation.

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Pregnancy, for instance, increases folate patients with macrocytic anemia, regardless of cause, with requirements 5 to 10-fold by the third trimester. Hereditary Spherocytosis Patients with mild folate deficiency often present with ane mia on a routine blood screening. The latter is thought to reflect more recent ing hereditary elliptocytosis and hereditary stomatocytosis. In cases where diagnosis remains in doubt, an elevated homocysteine level, in spite of a normal methyl Prevention malonic acid level, suggests folate deficiency. For patients who have required splenectomy, immunization against Pneumococcus and Meningococcus is recommended Treatment for secondary prevention of sepsis. Foods rich in folic acid should be consumed, which include leafy green vegetables, fruits, nuts, beans, wheat germ, and Clinical Findings liver. Individuals requirements, such as pregnant women, should receive with mild disease rarely manifest symptoms and signs. These patients often present as adoles Deficiency cents or adults on routine blood screenings. If bilirubin levels are chronically elevated, bilirubin gall stones can form, leading to right upper quadrant abdominal Recent exposure to oxidizing substances such as pri pain and tenderness, nausea, and a positive Murphy sign. Laboratory Findings General Considerations Patients with mild disease may or may not be anemic. The therefore experience intermittent hemolysis, generally asso newer acidified glycerol lysis test is also used. In addition to being normal by-products virtually eliminates the need for transfusion, these patients of cell metabolism, these substances are produced by certain are at risk for overwhelming sepsis with encapsulated organ drugs, household chemicals, and foods. Cholecystectomy may be Clinical Findings necessary for patients with bilirubin gallstones. However, a spectrum of clinical manifestations can An X, Mohandas N: Disorders of red cell membrane. Although vitamin E and splenec Medications tomy have been advocated as possible treatments in more Aspirin, nonsteroidal anti-inflammatory drugs Antimalarial agents severe cases, neither has provided consistent benefit. Chemicals that can cause such an insult include primaquine, Autosomal-recessive inheritance. Aspirin and acetaminophen can precipitate hemolysis in certain individuals as well. Attacks can also be associated with infections (such as pneumonia, viral hepatitis, General Considerations and Salmonella) and diabetic ketoacidosis. They tend to in highly susceptible individuals, Hb levels can be as low as 3 have mild, if any, clinical manifestations of disease. Many asymptomatic individuals, however, have only permutations of abnormal Hb genes can cause similar syn mildly depressed levels at 11-12 g/dL. Patients with one sickle cell gene and one thalassemia During periods of active hemolysis, other laboratory gene, for example, can have significant clinical manifestations measures can be abnormal. The white blood cell First, adequate hydration and oxygenation reduce the risk of count can be elevated at 12, 000-15, 000/mm3, even in the Hb polymerization and subsequent vasoocclusive crises. During Daily oral penicillin prophylaxis should be given until age 5 acute exacerbations, patients often require hydration and years. American Academy of Pediatrics; Section on Hematology/ Clinical Findings Oncology: Health supervision for children with sickle cell dis ease. Although generally no inciting factor is found, stresses such as cold, infection, and dehydration can precipitate attacks. Most patients experience autoinfarction of the spleen by early childhood due to occlusion of splenic capillary beds. Pneumonia, meningi Elevated indirect bilirubin and decreased serum hapto tis, osteomyelitis, and bacteremia are causes of significant globin. Pulmonary complications are the most common causes Inciting factor such as medication or illness. Depression, low self-esteem, and social withdrawal are common, espe cially when adequate coping mechanisms are not in place. Classically the patient has a reticulocyte Hematologic malignancies (chronic lymphocytic leukemia, non-Hodgkin count increased to 3%-15%, Hb mildly or moderately lymphoma) decreased to 7-11 g/dL, elevated direct bilirubin and lactate Infections (Mycoplasma, syphilis) dehydrogenase, and a depressed haptoglobin level. Treatment Pathogenesis Although further hemolysis can result, blood transfusion should be given when the Hb level is significantly low (5-7 Although in nearly half of cases the production of autoanti g/dL). Corticosteroids are often considered the treatment of bodies is idiopathic, at other times an inciting factor can be choice, especially when autoantibodies are warm. Lymphoproliferative disorders such as chronic lym need long-term treatment and cannot take steroids can use phoblastic leukemia and autoimmune disorders such as other immunomodulating agents such as azathioprine, rheumatoid arthritis, for example, can induce production of cyclosporine, and rituximab. Am J secondary prevention in the form of immunizations against Hematol 2002;69:258. The rate of disease progression There are many causes of extrinsic hemolysis not related to depends on the underlying cause of hemolysis. Other laboratory findings reflect the general hemolytic Infectious diseases such as malaria, babesiosis, and leish process. Levels of bilirubin and lactate dehydrogenase are maniasis can also cause an acquired hemolysis. This is due increased, haptoglobin levels tend to decrease, and the cor both to direct parasitic action and to increased activity of rected reticulocyte count is increased. Thrombotic thrombocytopenic purpura Physical destruction Pathogenesis Prosthetic valve March hemoglobinuria the etiology is unclear. Although some causative agents have Burns been shown to be directly toxic to the bone marrow, others Infection seem to induce an autoimmune process. The specific etiology Malaria, babesiosis plays a role in prognosis; drug-induced aplastic anemia car Leishmaniasis Medications ries a more favorable prognosis than idiopathic aplastic ane Primaquine mia. Symptoms and Signs Snake, spider venom Anemia leads to pallor, fatigue, and weakness. Toxins such as lead, copper, and arsine gas, as well as venom Pancytopenia is the hallmark of aplastic anemia. The Symptoms and signs, laboratory findings, and treatments reticulocyte count is often low. The white blood cell count can be lower than 1500/mm3 and the platelet count is gener will be based upon the specific diagnosis made. Rather than a specific disorder, extrinsic nonimmune hemolytic anemia ally less than 150, 000/mL. Am Fam Physician of aplastic anemia and important in distinguishing it from 2000;62:2255. Aplastic Anemia Patients with aplastic anemia should avoid sick contacts and razors. Other means of decreasing risk of infection include the use of stool softeners and antiseptic soaps. Hematopoietic growth factors (erythropoietin and granulocyte colony-stimulating factor) are not routinely General Considerations used due to transient or nil effect. In those lacking matched siblings or those older than 50 Reticulocyte count tends to be normal or decreased. The years, treatment consists of immunosuppression with antithy blood smear in the uremic patient can reveal acanthocytes, mocyte globulin, augmented with high-dose cyclosporine. Bone marrow is inappro Most patients relapse, but remission rates with additional priately normal for the degree of anemia. Prior to initiation of therapy, the patient should be screened for deficiency of iron, folate, and vitamin B12 as well as for occult blood loss. There is growing evidence that treatment with erythro poietin has a favorable effect on the progression of renal General Considerations disease, underscoring the importance of early diagnosis and treatment. Symptoms and Signs Underlying neoplastic, inflammatory, or metabolic dis Patients may exhibit bleeding or bruising due to thrombocy ease with nonspecific systemic signs and symptoms. Early symptoms of uremia include nausea, vomit ing, weight loss, malaise, and headache.


  • https://www.ecronicon.com/ecprm/pdf/ECPRM-04-00100.pdf
  • https://www.mdanderson.org/documents/for-physicians/algorithms/clinical-management/clin-management-cytokine-release-web-algorithm.pdf
  • https://questdiagnostics.com/hcp/intguide/Immuno/Complement_Glovsky.pdf
  • https://www.cdc.gov/asthma/pdfs/asthma_brochure.pdf
  • https://www.biorxiv.org/content/10.1101/664912v1.full.pdf

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